scholarly journals Assessment of the “July Effect”: outcomes after early resident transition in adult neurosurgery

2016 ◽  
Vol 125 (1) ◽  
pp. 213-221 ◽  
Author(s):  
Bryan A. Lieber ◽  
Geoffrey Appelboom ◽  
Blake E. S. Taylor ◽  
Hani Malone ◽  
Nitin Agarwal ◽  
...  
Keyword(s):  
Transition Period ◽  
Outcome Data ◽  
Training System ◽  
Transitional Period ◽  
Morbidity And Mortality ◽  
Improvement Program ◽  
Or Efficiency ◽  
Resident Physicians ◽  
July Effect ◽  
Academic Year

OBJECT Each July, 4th-year medical students become 1st-year resident physicians and have much greater responsibility in making management decisions. In addition, incumbent residents and fellows advance to their next postgraduate year and face greater challenges. It has been suggested that among patients who have resident physicians as members of their neurosurgical team, this transition may be associated with increased rates of morbidity and mortality, a phenomenon known as the “July Effect.” In this study, the authors compared morbidity and mortality rates between the initial and later months of the academic year to determine whether there is truly a July Effect that has an impact on this patient population. METHODS The authors compared 30-day postoperative outcomes of neurosurgery performed by surgical teams that included resident physicians in training during the first academic quarter (Q1, July through September) with outcomes of neurosurgery performed with resident participation during the final academic quarter (Q4, April through June), using 2006–2012 data from the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Regression analyses were performed on outcome data that included mortality, surgical complications, and medical complications, which were graded as mild or severe. To determine whether a July Effect was present in subgroups, secondary analyses were performed to analyze the association of outcomes with each major neurosurgical subspecialty, the postgraduate year of the operating resident, and the academic quarter during which the surgery was performed. To control for possible seasonal trends in certain diseases, the authors compared patient outcomes at academic medical centers to those at community-based hospitals, where procedures were not performed by residents. In addition, the efficiency of academic centers was compared to that of community centers in terms of operative duration and total length of hospital stay. RESULTS Overall, there were no statistically significant differences in mortality, morbidity, or efficiency between the earlier and later quarters of the academic year, a finding that also held true among neurosurgical subspecialties and among postgraduate levels of training. There was, however, a slight increase in intraoperative transfusions associated with the transitional period in July (6.41% of procedures in Q4 compared to 7.99% in Q1 of the prior calendar year; p = 0.0005), which primarily occurred in cases involving junior (2nd- to 4th-year) residents. In addition, there was an increased rate of reoperation (1.73% in Q4 to 2.19% in Q1; p < 0.0001) observed mainly among senior (5th- to 7th-year) residents in the early academic months and not paralleled in our community cohort. CONCLUSIONS There is minimal evidence for a significant July Effect in adult neurosurgery. Our results suggest that, overall, the current resident training system provides enough guidance and support during this challenging transition period.

Upaya Meningkatkan Hasil Belajar IPA pada Materi Keseimbangan Ekosistem melalui Penerapan Model Contextual Teaching And Learning (CTL) Siswa Kelas VI SD Negeri 1 Manggeng

2020 ◽  
Vol 1 (3) ◽  
pp. 333-340
Author(s):  
Syarifah Roswan
Keyword(s):  
Learning Outcomes ◽  
Teaching And Learning ◽  
Student Learning Outcomes ◽  
Learning Outcome ◽  
Learning Model ◽  
Outcome Data ◽  
Contextual Teaching ◽  
Data Collection Technique ◽  
Written Test ◽  
Academic Year

The purpose of this study was to increase the learning outcomes of IPA in the Ecosystem Balance mate-rial through the application of the Contextual Teaching And Learning (CTL) learning model for class VI students of SD Negeri 1 Manggeng for the 2017/2018 academic year. The research methodology is Classroom Action Research (CAR) consisting of two cycles and each cycle consisting of two findings. Each cycle consists of planning, implementing, observing and reflecting. The data collection technique is to collect test scores that are carried out at the end of each lesson in each cycle using a question in-strument (written test). The learning outcome data were analyzed by means of percentage statistics. The results showed that the completeness of student learning outcomes increased from 66,67% in the first cycle and increased to 83,33% in the second cycle. The application of the Contextual Teaching And Learning (CTL) learning model can increase the learning outcomes of IPA in the Ecosystem Balance material of class VI SD Negeri 1 Manggeng for the 2017/2018 academic year

scholarly journals Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos, Nigeria: A retrospective cohort study

2020 ◽  
Author(s):  
Akin Osibogun ◽  
Akin Abayomi ◽  
Oluchi Kanma-Okafor ◽  
Jide Idris ◽  
Abimbola Bowale ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critical Illness ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Outcome Data ◽  
Morbidity And Mortality ◽  
P Value ◽  
Hypertensive Patients ◽  
Increased Risk

Abstract Background: The current pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients. The morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described.Methods: In this retrospective cohort study all confirmed COVID-19 adult patients (≥18 years of age) in Lagos between February 27 to July 6 2020 were included. Demographic, clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos. Outcomes included dying, being discharged after recovery or being evacuated/transferred. Descriptive statistics considered proportions, means and medians. The Chi-square and Fisher’s exact tests were used in determining associations between variables. Kaplan–Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders. P-value ≤0.05 was considered statistically significant.Results: A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension, the most common comorbidity, was 17.8% followed by diabetes (7.2%) and asthma (2.0%). Overall mortality was 4.2% while mortality among the hypertensives was 13.7%. Severe symptoms and mortality were significantly higher among the hypertensives and survival rates were significantly lowered by the presence of an additional comorbidity to 50% from 91% for those with hypertension alone and from 98% for all other patients (P<0.001). After adjustment for confounders (age and sex), severe COVID-19and death were higher for hypertensives {severe/critical illness: HR=2.41, P=0.001, 95%CI=1.4–4.0, death: HR=2.30, P=0.001, 95%CI=1.2–4.6, for those with hypertension only} {severe/critical illness: HR=3.76, P=0.001, 95%CI=2.1–6.4, death: crude HR=6.63, P=0.001, 95%CI=3.4–1.6, for those with additional comorbidities}. Hypertension posed an increased risk of severe morbidity (approx. 4-fold) and death (approx. 7-fold) from COVID-19 in the presence of multiple comorbidities. Conclusion: The potential morbidity and mortality risks of hypertension especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication. This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future antiviral interventions.

scholarly journals Intestinal Perforations Associated With a High Mortality and Frequent Complications During an Epidemic of Multidrug-resistant Typhoid Fever in Blantyre, Malawi

2020 ◽  
Vol 71 (Supplement_2) ◽  
pp. S96-S101
Author(s):  
Franziska Olgemoeller ◽  
Jonathan J Waluza ◽  
Dalitso Zeka ◽  
Jillian S Gauld ◽  
Peter J Diggle ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Low Income ◽  
Intestinal Perforation ◽  
Bowel Perforation ◽  
Temporal Trends ◽  
Case Fatality ◽  
Salmonella Typhi ◽  
Outcome Data ◽  
Morbidity And Mortality ◽  
Abdominal Viscus

Abstract Background Typhoid fever remains a major source of morbidity and mortality in low-income settings. Its most feared complication is intestinal perforation. However, due to the paucity of diagnostic facilities in typhoid-endemic settings, including microbiology, histopathology, and radiology, the etiology of intestinal perforation is frequently assumed but rarely confirmed. This poses a challenge for accurately estimating burden of disease. Methods We recruited a prospective cohort of patients with confirmed intestinal perforation in 2016 and performed enhanced microbiological investigations (blood and tissue culture, plus tissue polymerase chain reaction [PCR] for Salmonella Typhi). In addition, we used a Poisson generalized linear model to estimate excess perforations attributed to the typhoid epidemic, using temporal trends in S. Typhi bloodstream infection and perforated abdominal viscus at Queen Elizabeth Central Hospital from 2008–2017. Results We recruited 23 patients with intraoperative findings consistent with intestinal perforation. 50% (11/22) of patients recruited were culture or PCR positive for S. Typhi. Case fatality rate from typhoid-associated intestinal perforation was substantial at 18% (2/11). Our statistical model estimates that culture-confirmed cases of typhoid fever lead to an excess of 0.046 perforations per clinical typhoid fever case (95% CI, .03–.06). We therefore estimate that typhoid fever accounts for 43% of all bowel perforation during the period of enhanced surveillance. Conclusions The morbidity and mortality associated with typhoid abdominal perforations are high. By placing clinical outcome data from a cohort in the context of longitudinal surgical registers and bacteremia data, we describe a valuable approach to adjusting estimates of the burden of typhoid fever.

Endovascular Therapy for Acute Mesenteric Ischemia: An NSQIP Analysis

2015 ◽  
Vol 81 (11) ◽  
pp. 1170-1176 ◽  
Author(s):  
Bernardino C. Branco ◽  
Miguel F. Montero-Baker ◽  
Hassan Aziz ◽  
Zachary Taylor ◽  
Joseph L. Mills
Keyword(s):  
Endovascular Therapy ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Improvement Program ◽  
Risk Of Death ◽  
Transfusion Requirements ◽  
Emergency Surgical Intervention ◽  
The Impact

Acute mesenteric ischemia (AMI) continues to carry high morbidity and mortality. Endovascular strategies have been increasingly used in the management of AMI. The purpose of this study was to evaluate the impact of endovascular therapy on outcomes of patients with AMI. The National Surgical Quality Improvement Program database was queried to identify all patients requiring emergency surgical intervention for AMI. Demographics, clinical data, interventions, and outcomes were extracted. Patients were compared according to treatment (endovascular versus hybrid versus open revascularization). Over the six-year study period, a total of 439 patients were found to have AMI [27 (6.2%) endovascular, 23 (5.2%) hybrid, and 389 (88.6%) open revascularization]. A total of 16 (59.3%) patients in the endovascular group avoided laparotomy. There was a trend toward lower transfusion requirements (intraoperative transfusion: 3.7% for endovascular vs 17.4% for hybrid vs 19.3% for open, adjusted. P = 0.127) and complications in particular pneumonia (22.2% vs 39.1% vs 27.8%, respectively, Adj. P = 0.392) and sepsis (25.9% vs 21.7% vs 35.5%, adjusted P = 0.260). Endovascular therapy was associated with a 2.5-fold decrease in the risk of death [odds ratio, 95% confidence interval: 0.4 (0.2, 0.9), adjusted P = 0.018]. In this analysis of morbidity and mortality, endovascular therapy was associated with decreased need for laparotomy and a trend toward lower transfusion requirements and complications, in particular pneumonia and sepsis. Endovascular first therapy was associated with a 2.5-fold decrease in the risk of death. Further prospective evaluation of these results is warranted.

scholarly journals Outcomes of Revascularized Acute Mesenteric Ischemia in the American College of Surgeons National Surgical Quality Improvement Program Database

2011 ◽  
Vol 77 (7) ◽  
pp. 832-838 ◽  
Author(s):  
William B. Newton ◽  
Matthew J. Sagransky ◽  
Jeanette S. Andrews ◽  
Kimberly J. Hansen ◽  
Matthew A. Corriere ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mesenteric Ischemia ◽  
Mortality Rates ◽  
Quality Improvement Program ◽  
Morbidity And Mortality ◽  
Definitive Treatment ◽  
Mortality Data ◽  
Improvement Program ◽  
Surgical Quality ◽  
American College Of Surgeons

This report examines outcomes of revascularization for acute arterial mesenteric ischemia (AAMI) using the American College of Surgeons National Surgical Quality Improvement Program database. Patients with International Classification of Diseases, 9th Revision and Current Procedural Terminology codes indicating AAMI with concomitant mesenteric revascularization were identified. Demographic, risk factor, procedural, morbidity, and mortality data were examined. Associations with morbidity and mortality were analyzed by logistic regression. One hundred forty-two cases of AAMI were identified. Seventy-one cases were thrombotic and 71 were embolic according to revascularization codes. Mean age was 66 years, 84 per cent of patients were white, and 54 per cent were female. Unadjusted major morbidity and mortality rates were 69 and 30 per cent, respectively. Patients with thrombotic AAMI were more likely to have a lower body mass index, greater than 10 per cent weight loss in the past 6 months, and a history of smoking. Patients with embolic AAMI were more likely to present emergently with sepsis. Unadjusted morbidity and mortality rates were 78 and 38 per cent for embolic and 61 and 23 per cent for thrombotic AAMI, respectively. Multi-variable predictors of morbidity included bowel resection at the time of revascularization, transfer admission, and involvement of a surgical resident. Multivariable predictors of mortality included impaired functional status, increased age, and postoperative sepsis. Cause of AAMI was not a significant predictor of morbidity or mortality. In a large sample of AAMI cases, AAMI remained a highly lethal and morbid condition. Predictors of morbidity and mortality included indicators of advanced presentation, treatment delay, and patient-related factors specific to AAMI, including debility and advanced age. Efforts directed at prevention and increasing the speed of diagnosis and definitive treatment appear to be necessary to improve outcomes.

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